Organización y desincronización de los ritmos circadianos en enfermeras y matronas italianas: actividades sociales y laborales

INTRODUCTION: Biological rhythms are present in all living organisms. The circadian rhythm (from the latin circa dies), with a duration of approximately 24 hours, is the most commonly studied in human beings. Biological rhythms are characterized by multiple molecular mechanisms aiming at synchronization and adaptation of organism to the temporal variations of environment. The circadian individual preference (chronotype) represents the phenotypic manifestation of such a complex mechanism, in many behavioral and daily living aspects. As far the late 70’s of the last century, Horne and Ostberg identified individual differences in circadian attitudes and defined different chronotypes by means of a self-assessed questionnaires with a defined score. Belonging to a defined chronotype seems to have an impact on everydays activities including working. On the other hand, the biological circadian rhythms could be disrupted by everydays activities leading to desynchronization. It has been reported two main types of desynchronization: fast (jet lag) and slow (shift work). Recently, also tlso the change due to Daylight Saving Time (DST) has been identified as a desynchronizing condition with possible negative impact on health. Thus, the starting hypothesis of this doctoral thesis is that social and working activities and chronotype may be closely related, and desynchronization, eg, shift work and DST, should be taken into consideration in Italian midwives. OBJECTIVES: General To determine the effect of chronotype and desynchronization of circadian rhythms (shift work and DST) on social and working activities in Italian midwives. Specific - To assess individual circadian preferences, effects on sleep, and quality of life perceived by midwives. - To determine the effect of the chronotype on social and working activities. - To evaluate the association between the biannual DST and labor activity. - To determine the effect of shift work and the time change on social and work activities. MATERIAL AND METHODS: Two approaches were used: a) Observational study: by the use of validated questionnaires administered through social networks, registered midwives belonging to the Italian Board of Nursing of Midwifery were investigated during 2019. The variables evaluated were individual circadian preference, work shift, working experience, fear of medication errors and sociodemographic, such as age and educational level. A cluster analysis was carried out to know the association between variables. b) Retrospective case-control study using administrative databases: the certificates of attendance at birth generated during the period 2016-2018 in the Region of Emilia-Romagna of Italy were considered. The number of spontaneous deliveries two weeks before (control) and after DST (cases) were analyzed. Further variables, such as gestational age, type of delivery, delivery time, newborn’s weight, Apgar test 5 minutes after delivery, and the use of analgesia during delivery, were evaluated. Univariate and multivariate analyses (logistic regression analysis) were carried out. RESULTS: In the first part of the work, 401 midwives (98.8% women) were enrolled. The mean age was 38.5 }10.1 years and the most common chronotypes were intermediate (50.3%) and moderately morning (39%). Nearly fifty percent of cases self-perceived risk of medication error “at least once”. Perception of risk of medication error was associated with midwifes aged between 31-35 years, undergoing shift work, with a working experience between 6-10 years, and having an intermediate chronotype. In the second study, 7415 spontaneous deliveries were evaluated, the mean age of the women was 31.4 } 10.1 years, and gestational age 39.3 } 1.4 weeks. No significant differences were found between the number of deliveries before and after DST. There were no significant differences for the mode of delivery, gestational age and the number of spontaneous deliveries. Gestational time, newborn weight, Apgar test 5 minutes after delivery, and use of analgesia did not show statistical significance as well. Mother’s age was the only variable found to be independently associated with delivery during the two weeks after DST. CONCLUSIONS The chronotype and shift work in Italian midwives influence professional self-perception, specifically the perception of risk of medication error. Younger midwives, with lower working experience, engaged in shift work and belonging to an Intermediate chronotype, seem to be at higher risk of potential medication error. Morning hours seem to represent highest risk frame for female healthcare workers and shift work is not always aligned with individual circadian preference. Thus, some suggested practical applications could include, for example, assessment of individual chronotype and sleep attitude in healthcare personnel, specific training programs, and intervention strategies, such as time-scheduled naps during night-shifts. As for the potential rhythm disruption operated by DST, the present study did not find any differences in the number of deliveries in the weeks following time shifts. This finding is in agreement with previous data obtained at quite different conditions of latitude, climate, and light exposure. It is possible that the multihormonal etiology of labor may explain this phenomenon. Further studies extended to different latitudes and ethnicities, could be very useful to verify the possibility of a generalization.INTRODUCCIÓN: Los ritmos biológicos están presentes en todos los organismos vivos. El ritmo circadiano (del latín circa dies), con una duración aproximada de 24 horas, es el más estudiado en seres humanos. Los ritmos biológicos se caracterizan por múltiples mecanismos moleculares que se encargan de la sincronización y adaptación del organismo a las variaciones temporales del entorno. La preferencia individual circadiana (cronotipo) representa la manifestación fenotípica, de un mecanismo tan complejo, en muchos aspectos conductuales y de la vida diaria. Ya a finales de la década de los 70 del siglo pasado, Horne y Ostberg identificaron diferencias individuales en las actitudes circadianas y definieron diferentes cronotipos mediante cuestionarios autoevaluados con una puntuación definida. La pertenencia a un cronotipo definido parece tener un impacto en las actividades cotidianas, incluido el trabajo. Por otro lado, los ritmos circadianos biológicos podrían verse interrumpidos por las actividades cotidianas que conducen a la desincronización. Se ha informado de dos tipos principales de desincronización: rápida (jet lag) y lenta (trabajo por turnos). Recientemente, también se ha identificado el cambio debido al horario de verano o Daylight Saving Time (DST) como una condición desincronizante con posible impacto negativo en la salud. Por tanto, la hipótesis de partida de la presente tesis doctoral es que las actividades sociales y laborales y el cronotipo pueden estar estrechamente relacionados, y la desincronización, por ejemplo, el trabajo por turnos y el horario de verano, debe tenerse en cuenta en las matronas italianas. OBJETIVOS: General: Determinar el efecto del cronotipo y la desincronización de los ritmos circadianos (trabajo por turnos y DST) sobre las actividades sociales y laborales de las matronas italianas. Específicos: - Evaluar las preferencias circadianas individuales, los efectos sobre el sueño y la calidad de vida percibida por las parteras. - Determinar el efecto del cronotipo en las actividades sociales y laborales. - Evaluar la asociación entre DST y la actividad laboral. - Determinar el efecto del trabajo por turnos y DST en las actividades sociolaborales. MATERIAL Y MÉTODOS: Se emplearon dos enfoques: a) Estudio observacional empleando cuestionarios validados a través de redes sociales, durante el año 2019. Los sujetos de estudios fueron matronas colegiadas en la Italian Board of Nursing and Midwifery. Las variables estudiadas fueron la preferencia circadiana individual, así como datos laborales (turno de trabajo, experiencia laboral, presencia de errores de medicación) y sociodemográficos (edad, nivel de estudios, sexo). Se llevo a cabo un análisis por clúster para conocer la asociación entre variables. b) Estudio caso-control retrospectivo empleando bases de datos administrativas, concretamente los certificados de asistencia al parto generados durante el periodo 2016-2018 en la Región de Emilia- Romagna, Italia. Se analizo el número de partos espontáneos 2 semanas antes (control) y después del DST (casos). También se analizaron otras variables secundarias como la edad gestacional, tipo de parto, tiempo de parto, peso del recién nacido, test de Apgar a los 5 minutos del parto y el uso de analgesia durante el parto. Se llevo a cabo un análisis univariante y multivariante (análisis de regresión logística). RESULTADOS: En la primera parte del trabajo, participaron 401 matronas (98,8% mujeres), con una edad media de 38,5 }10,1 años y siendo los cronotipos más comunes los intermedios (50.3 %) y moderadamente matutinos (39%). El 48.1% de los casos auto percibían que habían tenido “al menos una vez” riesgo de error de medicación. La percepción de riesgo de error de medicación se asoció con profesionales con una edad entre 31-35 años, que trabajaban a turnos, con una experiencia laboral entre 6-10 años, y un cronotipo intermedio. Por otra parte, en el segundo enfoque, se evaluaron 7415 partos espontáneos, siendo la edad media de las mujeres de 31,4 }10,1 años, con una edad gestacinal de 39,3 }1,4 semanas y siendo el 64,7% italianas. No se encontraron diferencias significativas entre el número de partos antes y después del DST. No hubo diferencias significativas para el modo de parto, edad gestacional y el número de partos espontáneos. El tiempo gestacional, peso del recién nacido, test de Apgar a os 5 minutos del parto y uso de analgesia tampoco mostraron una significación estadística. La única variable que se asociaba independientemente con el parto durante las dos semanas posteriores al DST fue la edad de la madre. CONCLUSIONES: El cronotipo y el trabajo a turnos en las matronas italianas influyen en el ámbito laboral, concretamente en la percepción de riesgo de error de medicación. Las matronas más jóvenes, con menor experiencia laboral, que realizan trabajo por turnos y pertenecen a un cronotipo intermedio, parecen tener un mayor riesgo potencial de error de medicación. Las horas de la mañana parecen representar el periodo de mayor riesgo para las trabajadoras de la salud y el trabajo por turnos no siempre está alineado con la preferencia circadiana individual. Por tanto, algunas aplicaciones prácticas sugeridas podrían incluir, por ejemplo, la evaluación del cronotipo individual y patrón del sueño en el personal sanitario, programas de formación específicos y estrategias de intervención, como las siestas programadas durante los turnos de noche. En cuanto a la posible alteración del ritmo operada por DST, no se encontraron diferencias en el número de partos en las semanas posteriores al cambio de hora. Este hallazgo está de acuerdo con datos anteriores obtenidos en condiciones bastante diferentes de latitud, clima y exposición a la luz. Es posible que la etiología multihormonal del trabajo de parto pueda explicar este fenómeno. Otros estudios extendidos a diferentes latitudes y etnias podrían ser útiles para la generalización de los hallazgos encontrados

SARS-CoV-2 pandemic: An overview

By the end of May 2020, SARS-CoV-2 pandemic caused more than 350,000 deaths worldwide. In the first months, there have been uncertainties on almost any area: infection transmission route, virus origin and persistence in the environment, diagnostic tests, therapeutic approach, high-risk subjects, lethality, and containment policies. We provide an updated summary of the current knowledge on the pandemic, discussing the available evidence on the effectiveness of the adopted mitigation strategies

Weekend Effect and in-Hospital Mortality in Elderly Patients with Acute Kidney Injury. A Retrospective Analysis of a National Hospital Database in Italy

Background: The aim of this study was to relate the weekend (WE) effect and acute kidney injury (AKI) in elderly patients by using the Italian National Hospital Database (NHD). Methods: Hospitalizations with AKI of subjects aged >= 65 years from 2000-2015 who were identified by the ICD-9-CM were included. Admissions from Friday to Sunday were considered as WE, while all the other days were weekdays (WD). In-hospital mortality (IHM) was our outcome, and the comorbidity burden was calculated by the modified Elixhauser Index (mEI), based on ICD-9-CM codes. Results: 760,664 hospitalizations were analyzed. Mean age was 80.5 +/- 7.8 years and 52.2% were males. Of the studied patients, 9% underwent dialysis treatment, 24.3% were admitted during WE, and IHM was 27.7%. Deceased patients were more frequently comorbid males, with higher age, treated with dialysis more frequently, and had higher admission during WE. WE hospitalizations were more frequent in males, and in older patients with higher mEI. IHM was independently associated with dialysis-dependent AKI (OR 2.711; 95%CI 2.667-2.755,p< 0.001), WE admission (OR 1.113; 95%CI 1.100-1.126,p< 0.001), and mEI (OR 1.056; 95% CI 1.055-1.057,p< 0.001). Discussion: Italian elderly patients admitted during WE with AKI are exposed to a higher risk of IHM, especially if they need dialysis treatment and have high comorbidity burden

Acute Kidney Injury and In-Hospital Mortality. A Retrospective Analysis of a Nationwide Administrative Database of Elderly Subjects in Italy

Background: The aim of this study was to investigate the association between acute kidney injury (AKI) and in-hospital mortality (IHM) in a large nationwide cohort of elderly subjects in Italy. Methods: We analyzed the hospitalization data of all patients aged >= 65 years, who were discharged with a diagnosis of AKI, which was identified by the presence of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), and extracted from the Italian Health Ministry database (January 2000 to December 2015). Data regarding age, gender, dialysis treatment, and comorbidity, including the development of sepsis, were also collected. Results: We evaluated 760,664 hospitalizations, the mean age was 80.5 +/- 7.8 years, males represented 52.2% of the population, and 9% underwent dialysis treatment. IHM was 27.7% (210,661 admissions): Deceased patients were more likely to be older, undergoing dialysis treatment, and to be sicker than the survivors. The population was classified on the basis of tertiles of comorbidity score (the first group 7.48 +/- 1.99, the second 13.67 +/- 2,04, and third 22.12 +/- 4.13). IHM was higher in the third tertile, whilst dialysis-dependent AKI was highest in the first. Dialysis-dependent AKI was associated with an odds ratios (OR) of 2.721; 95% confidence interval (CI) 2.676-2.766; p < 0.001, development of sepsis was associated with an OR of 1.990; 95% CI 1.948-2.033; p < 0.001, the second tertile of comorbidity was associated with an OR of 1.750; 95% CI 1.726-1.774; p < 0.001, and the third tertile of comorbidity was associated with an OR of 2.522; 95% CI 2.486-2.559; p < 0.001. Conclusions: In elderly subjects with AKI discharge codes, IHM is a frequent complication affecting more than a quarter of the investigated population. The increasing burden of comorbidity, dialysis-dependent AKI, and sepsis are the major risk factors

Treatment with ACE inhibitors or ARBs and risk of severe/lethal COVID-19: a meta-analysis

Objective: It has been hypothesised that the use of ACE inhibitors and angiotensin receptor blockers (ARBs) might either increase or reduce the risk of severe or lethal COVID-19. The findings from the available observational studies varied, and summary estimates are urgently needed to elucidate whether these drugs should be suspended during the pandemic, or patients and physicians should be definitely reassured. This meta-analysis of adjusted observational data aimed to summarise the existing evidence on the association between these medications and severe/lethal COVID-19. Methods: We searched MedLine, Scopus and preprint repositories up to 8 June 2020 to retrieve cohort or case-control studies comparing the risk of severe/fatal COVID-19 (either mechanical ventilation, intensive care unit admission or death), among hypertensive subjects treated with: (1) ACE inhibitors, (2) ARBs and (3) both, versus untreated subjects. Data were combined using a random-effect generic inverse variance approach. Results: Ten studies, enrolling 9890 hypertensive subjects were included in the analyses. Compared with untreated subjects, those using either ACE inhibitors or ARBs showed a similar risk of severe or lethal COVID-19 (summary OR: 0.90; 95% CI 0.65 to 1.26 for ACE inhibitors; 0.92; 95% CI 0.75 to 1.12 for ARBs). The results did not change when both drugs were considered together, when death was the outcome and excluding the studies with significant, divergent results. Conclusion: The present meta-analysis strongly supports the recommendation of several scientific societies to continue ARBs or ACE inhibitors for all patients, unless otherwise advised by their physicians who should thus be reassured

Google Trends on Obesity, Smoking and Alcoholism: Global and Country-Specific Interest

Unhealthy habits or lifestyles, such as obesity, smoking, and alcohol consumption, are involved in the development of non-communicable diseases. The aim of this study was to analyze different communities’ interest in seeking obesity, smoking, and alcohol-related terms through relative search volumes (RSVs) of Google Trends (GT). Internet search query data on obesity, smoking, and alcohol-related terms were obtained from GT from the period between 2010 and 2020. Comparisons and correlations between different topics were calculated considering both global searches and English-, Spanish-, and Italian-speaking areas. Globally, the RSVs for obesity and alcohol-related terms were similar (mean RSVs: 76% and 77%), but they were lower for smoking (65%). High RSVs were found in winter for obesity and smoking-related terms. Worldwide, a negative correlation was found between alcohol and smoking terms (r = −0.72, p < 0.01). In Italy, the correlation was positive (r = 0.58). The correlation between obesity and alcohol was positive in all the cases considered. The interest of global citizens in obesity, smoking, and alcohol was high. The RSVs for obesity were globally higher and correlated with alcohol. Alcohol and smoking terms were related depending on the area considered

Individual Circadian Preference, Eating Disorders and Obesity in Children and Adolescents: A Dangerous Liaison? A Systematic Review and a Meta-Analysis

Obesity and other eating disorders are an actual public health problem, especially in childhood and adolescents, and could be also related with chronotype. The aim of this systematic review was to determine the relationship between eating disorders, obesity and the different chronotypes in children and adolescents. Methods: A systematic review of observational studies evaluating young populations dealing with and evaluating chronotype was conducted. Electronic searches were performed in six international databases. A qualitative thematic-categorical analysis was carried out and a random-effects model was used for the quantitative analysis (meta-analysis). Results: Fifteen studies were included, but quantitative analysis was only carried out in three of them. Children and adolescents with an evening chronotype had higher body mass index, consumed more junk food or were more predisposed to suffer from food addiction and night eating syndrome. Conclusions: Children and adolescents with evening chronotype had higher tendency to incorrect eating behaviors and were suffering from overweight/obesity. Environment but also lifestyle factors should be considered in the association between chronotype and eating disorders and obesity

Daylight Saving Time and Spontaneous Deliveries: A Case–Control Study in Italy

(1) Background: Although the current literature shows that daylight saving time (DST) may play a role in human health and behavior, this topic has been poorly investigated with reference to Obstetrics. The aim of this case–control study was to evaluate whether DST may influence the number of spontaneous deliveries. (2) Methods: A low-risk pregnancy cohort with spontaneous onset of labor (n = 7415) was analyzed from a single Italian region for the period 2016–2018. Primary outcome was the number of spontaneous deliveries. Secondary outcomes were: gestational age at delivery, type and time of delivery, use of analgesia, birth weight, and 5-min Apgar at delivery. We compared the outcomes in the two weeks after DST (cases) to the two weeks before DST (controls). (3) Results: Data showed no significant difference between the number of deliveries occurring before and after DST (Chi-square = 0.546, p = 0.46). Vaginal deliveries at any gestational age showed no statistical difference between the two groups (Chi-square = 0.120, p = 0.73). There were no significant differences in the secondary outcomes, as well. (4) Conclusions: DST has neither a significant impact on the number of deliveries nor on the obstetric variables investigated by this study

Takotsubo syndrome, neurological disorders, and sex: a dangerous liaison?

No abstract present

Ora solare e ora legale, disturbi dei ritmi circadiani e salute generale

Le lancette degli orologi vengono spostate due volte l'anno per tenere conto delle variazioni stagionali della luce diurna e utilizzare al meglio quella disponibile in un dato periodo. Le disposizioni sull’ora legale risalgono alla prima guerra mondiale, al fine di risparmiare carbone per l'illuminazione. Il sistema dei cambi semestrali dell'ora è stato messo in discussione a livello del Parlamento europeo da alcuni paesi membri che ne hanno chiesto l’abolizione. Da una parte, vantaggi di tipo economico assai ridotti, dall’altra consistenti problemi di salute (e crescenti relative spese). Dopo una consultazione pubblica, la Commissione Europea ha proposto di porre fine ai cambi stagionali dell'ora, lasciando ai singoli Stati la scelta del proprio orario (solare o legale), purchè permanente, e tale proposta è stata definitivamente approvata dal Parlamento Europeo nel mese di marzo 2019. I problemi alla salute sostanzialmente derivano da disturbi dei ritmi circadiani dell’organismo. Ogni nostra funzione biologica viene supervisionata da una serie di meccanismi controllati dai ritmi circadiani, argomento che è valso il premio Nobel 2017 per la Medicina e la Fisiologia a tre ricercatori statunitensi. L’articolo illustra succintamente i complessi meccanismi che regolano l’organizzazione del nostro orologio biologico e le ripercussioni negative sulla salute conseguenti alla sua desincronizzazione